Transformation Technology Products

Products that are considered transformational dramatically change the way things have been done historically. For example, the automobile and the airplane each have forever changed how we travel, how far we travel and how often we travel.

When exploring transformational innovation, there are two primary components to consider. There is almost always a significant unmet need and the application of a significant advancement in technology that can be brought to bear upon that need.

The development of transformational products and procedures in medicine is no less striking. In the last decade, operations such as open-heart surgery have improved dramatically, from large, invasive incisions to smaller incisions with much less tissue damage. As a result, rehabilitation times have been cut considerably.

While there are many significant and dramatic advances in medicine, most of the improvements made during the past few decades have come as the result of small changes that over time result in evolutionary changes in design. Orthopaedics is one area that is ready for transformational innovation. There are still many significant unmet needs in orthopaedic treatments. One such area of orthopaedics is treating fractures of the hip.

Hip Fractures

Hip fractures are an all too common calamity awaiting the elderly population. These fractures often result from simple falls. Each year in the U.S., over 350,000 people are admitted to the hospital for hip fractures and 60,000 to nursing homes. The vast majority of these patients are elderly. As the U.S. population ages and becomes increasingly active in their later years, the number of hip fractures is expected to grow sharply.

History of Hip Fixation

Devices used to treat hip fractures today are the result of decades of development and improvement. In 1931, Dr. Smith-Petersen implanted the first tri-flange nail. This was significant because it paved the way for operative treatment of hip fractures. Today over 95% of all hip fractures are treated operatively.

In 1941, Jewett devised the combination nail/plate, thus increasing the surgeon's ability to stabilize the fracture fragments so that they could heal. In 1958, multiple pins were first used. During the 1960s and 1970s various compression hip screws were produced. This allowed for greater collapse of the fragments with lower risk of the device cutting out of the bone. The 1980s saw further development with intramedullary nail/hip screw devices.

Transformational Hip Fixation

If one criterion for transformational innovation is the presence of a significant unmet need, then does this need exist for hip fractures today? Consider the following statistics:

  • Over 5% of patients don't survive the initial hospital treatment.2
  • 33% of patients do not survive beyond one year after fracturing their hip 3, often due to lengthy rehabilitation.
  • The average hospital stay is 25 days.2
  • Only slightly more than half of patients are released to go home after hospitalization.2 Most others must move to a rehabilitation center or permanently into a long-term care facility.
  • 61% of patients never recover the level of mobility they had prior to the hip fracture.4
  • 60% of patients still have pain and worsened mobility attributed to the fracture two years after surgery.5

Current techniques for the fixation of hip fractures, while successful in repairing the fracture, often damage surrounding muscles and blood vessels. The result is significant weakening of the muscles, requiring lengthy rehabilitation.

One project underway in the Transformation Technologies group of Zimmer research is an innovative approach to treating hip fractures. The effort is attempting to provide fixation and controlled reduction of all types of hip fractures through a minimally invasive technique. By developing a surgical technique that reduces the size of the incision to 4 - 5 cm and through careful consideration to avoid cutting critical soft tissues, operative trauma to the patient can largely be avoided. The intended goal is for the muscles associated with the hip to be as strong after the surgery as before. It is hoped that this will greatly reduce the length of hospitalization and rehabilitation for the patient and result in a quicker and more complete return to function.

References

1. News Release. American Academy of Orthopedic Surgeons. Jan. 2001.

2. Smektala R, Wenning M, Ekkernkamp A.: Fracture of femoral neck: analysis of the results of external quality assurance. A report on 22, 556 patients. Chirurg 1999 Nov; 70 (11):1330-8.

3. Rose S, Maffulli N: Bull Hosp Jt Dis. 1999;58(4):197-201.

4. Koot VC, Peeters PH, de Jong JR, Clevers GJ, van der Werken C: Functional results after treatment of hip fracture: a multicentre, prospective study of 215 patients. Eur J Surg 2000 Jun;166(6):480-5.

5. Davidson CW, Merrilees MJ, Wilkinson TJ, McKie JS, Gilchrist NL: Hip fracture mortality and morbidity-can we do better? N Z Med J 2001Jul 27;114(1136):329-32.